When the secretions in the lacrimal sac turn into purulent secretions, it becomes chronic dacryocystitis. The main distinction between this condition and mucocele is the presence of a certain degree of diffuse congestion in the skin of the lacrimal sac area, along with more pronounced conjunctivitis and epiphora. In severe cases, a suppurative cyst may form.

bubble_chart Diagnosis

1. Epiphora.

2. When pressing the lacrimal sac area or irrigating the lacrimal passage, mucus or purulent discharge flows out from the lacrimal punctum, with no irrigation fluid entering the nasal cavity or pharynx.

3. When the discharge accumulates in large amounts, it can cause the lacrimal sac to expand, leading to local swelling. {|102|}

bubble_chart Treatment Measures

1. Frequent eye drops: Apply various antibiotic eye drops frequently to the affected eye, but first ensure the lacrimal sac pus is completely squeezed out.

2. Lacrimal duct irrigation: Use saline or antibiotics, hormones, or enzyme inhibitors (e.g., α-chymotrypsin) for irrigation.

3. Probing and dilation: This can be performed only after a period of irrigation when secretions have disappeared. Avoid excessive force to prevent false passage formation, infection spread, or worsening obstruction.

4. Surgical therapy: The primary method is dacryocystorhinostomy, but lacrimal sac excision may also be performed. Indications should be selected based on individual conditions. For patients with atrophic rhinitis, lupus, subcutaneous nodules, syphilis, perisaccal inflammation, suppurative ethmoid sinusitis, malignant tumors, corneal inflammation, endophthalmitis, or ocular trauma, lacrimal sac excision should be prioritized for safety. Dacryocystorhinostomy yields poor results for lower canaliculus obstruction. For simple mucocele, dacryocystorhinostomy is the preferred approach. Additionally, threading procedures are also an option.

Chronic dacryocystitis over a long period poses a serious threat to ocular safety. Infections such as corneal infections, creeping corneal ulcers, penetrating eye injuries, or intraocular surgeries can lead to panophthalmitis, resulting in the loss of visual function.

bubble_chart Differentiation

1. Sebaceous cysts are superficially located and generally do not have fistulas.

2. Cold abscess: Diagnosis can be confirmed by combining X-ray images with a detailed medical history.